Woman 82 yrs old. Biopsy from lateral nasal skin.  
CLINICALLY: "MTS" in lungs.  
HISTO: Pleomorphic dermal infiltrate with prominent angiocentricity, focal necrosis insuficcient for DLBCL diagnosis.  
IH: In IH slides CRUSHED BIOPTATE ONLY REMAINS, so quality is suboptimal. INFILTRATE: LCA 100%(+++)(membr.), CD20(+/++) 80% (citopl.), CD3(-)(except T ), CD5(-)(except T, which are CD3+ >> CD5+), CD56(-), Bcl2(++) 80% (citopl.), CyclinD1(-), Bcl6(+)<5% (nuclear), CD10(-), Mum1(+/++) 20% (nuclear), CD23(-), Ki67 prolif. activity 80% (brand. r-ja), CD34/TdT/EBV LPM1(-).  
 
PROPOSED DIAGNOSIS: B lymphoproliferation, most probably LyG (II°)vs DLBCL (LyG III°).  
Thank you for beeing 2gether.

tzankov 2008-07-14 14:22	For sure, it is an angiocentric "high grade" lymphoma. The morphology, the clinical prsentation with pulmonary involvement as well as the (suboptimal) stainings are all in support of LyG grade III, but I would like to see at least TIA-1 and another B-cell marker (CD79a).
ugnius 2008-07-14 14:25	Thank you. I'm afraid that the next IH session will not be effective at all. The block was exhausted before. We will inform about results.
yethuwin 2008-07-15 17:41	interesting case
hurwitz 2008-07-20 17:37	At the present stage the appearances are those of DLBCL with some evidence of angio-centricity. Areas with an inflammatory background showing also large atypical tumor cells, support your thesis of an LyG evolving to DLBCL. Age related immune deficiency can be postulated as a contributing factor. ISH for EBER would be helpful, but as far as I know, the method is not yet available in your laboratory.   "MTS" is an abbreviation not familiar to me. Does it mean metastases ? Please be so kind and do not use abbreviations except for the most common ones which are understandable for everybody, such as "NHL" for instance.
FFalko 2008-07-21 13:29	This looks like diffuse large B-cell lymphoma to me, with angiocentric features. For LYG grade 3, which morphologically would certainly be possible, presence of EBV should be proved. In my experience, LMP1 should be positive at least in some cells in LYG, but EBERs would be more conclusive.
dirnhofer 2008-07-21 18:46	from the present slides, it is dlbcl to me. lyg could be possible but would essentially require ebv-presence (and also some cd30 staining in tu cells and some kind of "immunosuppression"). if not demonstrable, i would not make that diagnosis (which has no therapeutic relevance since lyg grade 3 is treated like a dlbcl)
Mueller-Hermelink 2008-08-06 22:52	I am a little late but I am very concerned about the CD3 positivity. I have seen PTCL expressing CD 20 and would request further documentation of CD 79a, Pax 5 and T cell markersespecially CD 30 and cytotoxic markers. I am not to much impressed by the angiocenticity ( no necrosis!!!).
hurwitz 2008-08-06 23:26	Prof. Müller-Hermelinks comment about CD3 positivity is important. First thing I would like to see is a high power image in order to appreciate the morphology of the CD3 positive cells.
ugnius 2008-08-07 08:14	Thank you. I will be back soon at least with HPF.
ugnius 2008-08-08 08:53	Please find some confocal CD3/CD20/CD79a pictures and enlarged CD3. Unfortunatelly the block is exhausted and I realy cannot do anything else including PCR and Pax5. B and T populations seems to be different, but CD20+ reaction is very weak and undefinite (artefactual likea). CD79a+ is more definite and sharp. Thank you for continuous help. Appologies for being out of focus at least sometime.
ugnius 2008-08-08 18:22	The last CD79a from crushed rest of the tissue, The quality is LOW.
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